What is the room rent limit in your health insurance plan? How does it affect your claim settlement? Find out the truth, so you can make an informed decision and avail maximum benefits of your health insurance coverage.

Health insurance can be a real savior in times of dire need; however if you do not understand the complex clause that room rent capping is, you might be seriously disappointed when the time comes to claim settlement.

What is ROOM RENT CAPPING?

It is the pre-defined limit set on room charges that you may spend in case you are admitted to a hospital.

Here is a brief understanding of the different types of room rent limit:

Sub-Limit: If your policy defines a fixed cap or percentage of the total sum insured on the room expenses, then only charges up to the fixed sub-limit would be covered by your insurance company. For instance, if your room rent sub-limit is 1 % on a policy of about INR 2 lacs, then your room expenses cannot be more than INR 2000.

No Limit: If you choose a policy for health insurance without capping or limit, then there is virtually no restriction on the expense to be incurred.

Room Type -

If your policy defines the type of room you are admissible in, then your insurance coverage will be paid accordingly since the room charges vary as per the room type. Room types you can opt:

General Ward/ Shared Room: This room category is provided on a twin-sharing basis and is generally available for a sum insured amount that’s lower than Rs. 5 Lacs. It has less impact on premiums.

Single Private Room: A single private room is generally available for a sum insured amount of Rs. 5 lacs and above. There is no sub-limit on this room type.

Any Room: This is a suite room and is generally available for a sum insured of more than Rs. 7 lacs. It can also be availed of by paying an extra premium.

Impact of Room Type on Hospital Bills:

All the other charges, i.e. the doctor’s fees, medicine costs, nursing charges, and operation charges are levied on your ability to pay. So, your overall stay in a shared room will be considerably cheaper than that of a private room. However, when it comes to comfort and claim settlement, a private room with no sub-limit is clearly the better option. A slightly higher premium ensures that the quality of your stay is bettered and the insurance company is liable to take care of the claimed amount.

Impact of Room Rent Limit on Insurance Claims:

Insurance plans with a Sub-Limit or room type restrict the amount that you can claim during settlement. Since the limit that is permitted for reimbursement as per your claim is linked to the room rent, you might have to pay the remaining amount for non-admissible expenses out of your own pocket.

Disclaimer: The amounts mentioned in this article only serve as examples. The actual amounts may vary.

To conclude, health cover without any capping is the most beneficial when it comes to insurance claims. No matter what the charges might be, the insurance company will have to cover all the expenses. However, such plans come with a higher premium and leave you vulnerable to exhausting your insurance much earlier. So, if you can afford it and fall under the low-risk category, go for it. If not, then make sure that you read between the lines, and understand the limitations and extent of coverage to be available to you.

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